[e-drug] Re: Description/definition of essential drugs by WHO

E-drug: Re: Description/definition of essential drugs by WHO
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I guess one needs to consider what use the "definitions" are going
to be put to. In this case, one is considering population-perspectives
and not the individual level - to the individual, whatever medicine
they require is "essential". Without a population angle one would
simply remove the me-too medicines and those of unproven
efficacy and be left with a long, unmanageable list.

Likewise the concept of affordability - if it is not taken into account,
then many medicines will make it onto the list but will not/seldom
be used due to their cost. And it is possible that they will knock
cheaper medicines off the list which could otherwise make a
positive impact on health.

In our last review of the Zimbabwe EDL, a number of "essential"
medicines were included on the EDL but we all knew that there was
not a chance of them being available because the money to order
such expensive medicines was not there. What is the point of
including them if they are not affordable? One reason would be
political - to show that we have the medicines on the list (and
perhaps to use that as an arguement to reduce taxes and tarrifs on
them or to allow them to be made available through special
dispensations). Perhaps this is the reason that WHO are including
such unafforable medicines on their EDL - due to external pressure
on them that such drugs should be in the EDL and for them to also
use the EDL to argue for the costs of these medicines to be
reduced, etc.? Is this process acceptable or should the EDL be what
it claims to be?

Of course, the EDL is meant to be adapted by individual countries
and they can bring in the concept of affordability at the national
level (the idea of using cost-effectiveness is good but cannot be
separated from affordability). This assumes the necessary expertise
and ignores the powerful(?) influence that a particular medicine is
on the WHO EDL so it should be on the national list.

Regards,

Douglas Ball
Drug & Toxicology Information Service
Dept of Pharmacy
University of Zimbabwe
PO Box A 178, Avondale, HARARE
Tel: (263)(4)790233 Fax: (263)(4)795019
dball@healthnet.zw

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